amendment to contract inspection, testing and …

Tracking Number: 19050024

AMENDMENT TO CONTRACT Inspection, Testing and Maintenance of Fire Sprinklers

Bid No. 18-102 City of Lincoln and Lancaster County

Additional Services Mahoney Fire Sprinkler, Inc.

This Amendment is hereby entered into by and between Mahoney Fire Sprinkler, Inc., 5004 S. 110th St., Omaha, NE 68137 (hereinafter “Contractor”) and City of Lincoln and Lancaster County, (hereinafter “Owners”), for the purpose of amending the Contract dated July 12, 2018, executed under City Resolution No. A-91119, and County Contract C-18-0285, dated June 19, 2018 for Inspection, Testing and Maintenance of Fire Sprinklers, Bid No. 18-102, which is made a part hereof by this reference.

WHEREAS, the parties hereby amend the contract to add additional services for various City locations as per Attachment A; and

WHEREAS, the parties hereby amend the contract to add additional services for a County location as per Attachment B; and

WHEREAS the expenditures for the City of Lincoln is estimated to be $1,500.00 for the remainder of the current contract term without prior approval by the City of Lincoln; and

WHEREAS the expenditures for Lancaster County is estimated to be $400.00 for the remainder of the current contract term without prior approval by the Lancaster County Board of Commissioners; and

WHEREAS, the revised contract total with the additional services for the City of Lincoln is estimated to be $25,780.00; and

WHEREAS, the revised contract total with the expenditure increase for Lancaster County is estimated to be $10,400.00; and

NOW, THEREFORE, IN CONSIDERATION of the mutual covenants contained in the Contract, under City Resolution No. A-91119 and County Contract No. C-18-0285, and stated herein the parties agree as follows:

1) The parties hereby amend the contract to add additional services for various City locationsas per Attachment A.

2) The parties hereby amend the contract to add additional services for a County location asper Attachment B.

3) The expenditures for the City of Lincoln is estimated to be $1,500.00 for the remainder ofthe current contract term without prior approval by the City of Lincoln.

4) The expenditures for Lancaster County is estimated to be $400.00 for the remainder ofthe current contract term without prior approval by the Lancaster County Board ofCommissioners.

5) The revised contract total with the additional services for the City of Lincoln is estimatedto be $25,780.00.

6) The revised contract total with the expenditure increase for Lancaster County is estimatedto be $10,400.00.

7) All other terms of the Contract, not in conflict with this Amendment, shall remain in fullforce and effect.

C-19-0363


The Parties do hereby agree to all the terms and conditions of this Amendment. This Amendment shall be binding upon the parties, their heirs, administrators, executors, legal and personal representatives, successors, and assigns.

IN WITNESS WHEREOF, the Parties do hereby execute this Amendment upon completion of signatures on:

Vendor Signature Page City of Lincoln Signature Page Lancaster County Signature Page


Vendor Signature Page

AMENDMENT TO CONTRACTInspection, Testing and Maintenance of Fire Sprinklers

Bid No. 18-102City of Lincoln and Lancaster County

Additional ServicesMahoney Fire Sprinkler, Inc.

Please sign, date and return within 5 days of receipt.

Mail to: City/County PurchasingAttn: Debbie Winkler440 So. 8th St,, Ste. 200Lincoln, NE 68508Or email to: dwinkler@lincoln,ne.gov

Company Name: nO^h^ ^re. 'Spr^l/Ur, ^nc .^?tBy: (Please Sign)

By: (Please Print) TYJn WTitle:

^4. ±Company Address: 5Q'>q $„ II f)^ S^r-^ ^/^^./IE/4/.5r/,5-9Company Phone & Fax: W-^W 4 ^}3-5%-^W;E-Mail Address: Wi^aftmkM^

c^r c^c'jsm

Date: ^-\qContact Person for Orders orService QSormw

W^- S^ ^ ^/^ 5^5-/aoi/

(If

Contact Phone Number


City of Lincoln Signature Page

____________________________________________________________________________




EXECUTION BY THE CITY OF LINCOLN, NEBRASKA

ATTEST:

___________________________________ City Clerk

CITY OF LINCOLN, NEBRASKA

__________________________________________ Mayor

Approved by Executive Order No.____________

dated __________________________________


Lancaster County Signature Page

________________________________________________________________________________




EXECUTION BY LANCASTER COUNTY, NEBRASKA

The Board of County Commissioners of Lancaster, Nebraska

______________________________________

______________________________________

______________________________________

______________________________________

______________________________________

dated _________________________________

Contract Approved as to Form:

______________________________________ Deputy Lancaster County Attorney

C-19-0363

Mahoney Fire Sprinkler^ Inc.5004 S. 110th Street | Omaha, NE 68137

Attachment A

Phone (402)553-1221| Fax (402)553-4545

April 30, 2019

Bennett IVIartin Public Library

Attn: Julee Hammer1368.14th Street

Lincoln, NE 68508

Phone:(402)441-8511Email: ihammer@lincoln,ne.goy

Location: Bennett Martin Public Library - 136 S. 14th Street, Lincoln, NE 68508

Scope of Work: 5 Year Internal Pipe Inspection & Sprinkler Head Testing

This agreement to inspect and/or test the fire protection systems, as noted below, is made between

Mahoney Fire Sprinkler, Inc., and Bennett IVIartin Public Library (Subscriber).

Scope: Mahoney Fire Sprinkler, Inc. proposes, subject to Terms & Conditions, stated herein, to inspectand test the equipment and devices noted in accordance with the National Fire Protection Association-

NFPA 25, Nebraska State Fire Marshal and the recommendations of the manufacturer.

Our Price Includes:

• Drain fire sprinkler system; system will be returned to service when the work is complete

• Static and residual testing; tagging of all risers - 1 wet type fire sprinkler system

• Replacement of riser gauges and visual inspection of system piping alarms• NFPA 25 "5 year" performed on all systems

• Remove (4) 1967 Viking fire sprinkler heads for compliance testing

• Replace (4) fire sprinkler heads removed for testing with new

• Package and ship sprinkler heads to compliance laboratory for testing and results report

Five-Year Maintenance & Internal Pipe Inspection includes:Internal obstruction investigation, check valve cleaning & replacement of 2 gauges

Price and Terms of Payment: Subscriber shall pay to Mahoney Fire Sprinkler, Inc., in full, within 30days after the inspection is completed the sum of: Seven Hundred Dollars ('$700.00). This price is for

the equipment, service and frequency of service mentioned above. If additional equipment is added afterthe date of this agreement, the price will be changed to include the additional equipment.

Please Note:

• Please allow up to 14 days for compliance testing to be completed. Also, the above cost is only validif the work is done together/at the same time.

• This price is valid for 30 days. If accepting this proposal after 30 days, please contact our office.

Please call if you have any questions.

Sincerely,Mahoney Fire Sprinkler, Inc.

Jefp3ary\£^'

JeffBarnes

Service Manager

Accepted by:

Title:

Date:

Fire Sprinklers Save Lives

Mahoney Fire Sprinkler, Inc.5004 S. 110th Street | Omaha, NE 68137 Phone (402) 553-1221 | Fax (402) 553-4545

April 30, 2019

Wait Branch Library Phone: (402) 441-8511Attn: Julee Hammer Email: ihammer(%lincoln.ne.gov6701 S. 14th Street

Lincoln, NE 68512

Location: Wait Branch Library - 6701 S. 14th Street, Lincoln, NE 68512

Scope of Work: Fire Sprinkler Inspection (5 Year Internal Pipe Inspection)


Mahoney Fire Sprinkler, Inc., and Wait Branch Library (Subscriber).

Scope: Mahoney Fire Sprinkler, Inc. proposes, subject to Terms & Conditions, stated herein, to inspectand test the equipment and devices noted in accordance with the National Fire Protection Association-

NFPA 25, Nebraska State Fire JVtarshal and the recommendations of the manufacturer.

Our Price Includes:

• Static and residual testing

• Tagging of all risers - 1 wet fire sprinkler sytem

• Replacement of riser gauges

• Visual inspection of system piping alarms• NFPA 25 "5 year" performed on all systems

Five-Year Maintenance & Internal Pipe Inspection includes:Internal obstruction investigation, check valve cleaning & replacement of 2 gauges

Price and Terms of Payment: Subscriber shall pay to Mahoney Fire Sprinkler, Inc., in full, within 30days after the inspection is completed the sum of: Four Hundred Dollars ($400.00). This price is for


PleaseNote:



Sincerely,Mahoney Fire Sprinkler, Inc.

Jefp'Bam^'

JeffBarnes

Service Manager

Accepted by:

Title:

Date:


Mahoney Fire Sprinkler^ Inc.5004 S. 110th Street | Omaha, NE 68137 Phone (402) 553-1221 | Fax (402) 553-4545

April 30, 2019

Eiseley Branch Library Phone: (402) 441-8511Attn: Julee Hammer Email: ihammer(%lincoln.ne.gov

1530 Superior StreetLincoln, NE 68521

Location: Eiseley Branch Library - 1530 Superior Street, Lincoln, NE 68521



Mahoney Fire Sprinkler, Inc., and Eiseley Branch Library (Subscriber).

Scope: Mahoney Fire Sprinkler, Inc. proposes, subject to Terms & Conditions, stated herein, to inspectand test the equipment and devices noted in accordance with the National Fire Protection Association-NFPA 25, Nebraska State Fire Marshal and the recommendations of the manufacturer.

Our Price Includes:




• Visual inspection of system piping alarms

• NFPA 25 "5 year" performed on all systems

Five-Year Maintenance & Internal Pipe Inspection includes:

Internal obstruction investigation, check valve cleaning & replacement of 2 gauges

Price and Terms of Payment: Subscriber shall pay to Mahoney Fire Sprinkler, Inc., in full, within 30days after the inspection is completed the sum of: Four Hundred Dollars ('$400.00'). This price is for


Please Note:



Sincerely,Mahoney Fire Sprinkler, Inc. Accepted by:

Je^'Barn^ Title:

JeffBarnes Date:

Service Manager


Attachment B

Mahoney Fire Sprinkler^ Inc.5004 S. 110th Street | Omaha, NE 68137 Phone (402) 553-1221 | Fax (402) 553-4545

April 29, 2019

Lancaster County DMV Phone: (402) 441-8286

Attn: Dee Adams ' Email: dadams(%lancaster.ne.Rov

625 N. 46th Street

Lincoln, NE 68503

Location: Lancaster County DMV - 625 N. 46th Street, Lincoln, NE 68503


This agreement to inspect and/or test the fire protection systems, as noted below, is made betweenMEahoney Fire Sprinkler, Inc., and Lancaster County DMV (Subscriber).

Scope: Mahoney Fire Sprinkler, Inc. proposes, subject to Terms & Conditions, stated herein, to inspectand test the equipment and devices noted in accordance with the National Fire Protection Association -NFPA 25, Nebraska State Fire Marshal and the recommendations of the manufacturer.

Our Price Includes:




• Visual inspection of system piping alarms• NFPA 25 "5 year" performed on all systems

Five-Year JVIaintenance & Internal Pipe Inspection includes:

Internal obstruction investigation, check valve cleaning & replacement of 2 gauges

Price and Terms of Payment: Subscriber shall pay to Mahoney Fire Sprinkler, Inc., in full, within 30days after the inspection is completed the sum of: Four Hundred Dollars ('$400.00). This price is for

the equipment, service and frequency of service mentioned above. If additional equipment is added afterthe date of this agreement, the price will be changed to include the additional equipment,

Please Note:



Sincerely,

Mahoney Fire Sprinkler, Inc.

Jeft:3cu'ne^

JeffBarnes

Service IVtanager

Accepted by:

Title:

Date:


A.CORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

4/11/2019THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCERThe Harry A. Koch Co.P.O. Box 45279OmahaNE 68145-0279

INSURED MAH24348

Mahoney Fire Sprinkler, Inc.5004 S 11 Oth StreetOmahaNE 68137

CONTACTNAME:

PAH?NNEo.E,t>: 402-861-7000"FAX"

I'

ADDRESS: [email protected]

INSURER(S) AFFORDING COVERAGE

INSURER A

INSURERB

INSURERC

INSURER D

INSURERE

INSURERF

Travelers Property Casualty of America

Travelers Indemnity Co.

Charter Oak Fire Insurance Co.

NAICS

256742565825615

COVERAGES CERTIFICATE NUMBER; 427429927 REVISION NUMBER:THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSRLTR

G

A

A

B

TfPE OF INSURANCE

x

x

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE I x I OCCUR

$ 5,000 Ded

GEN'L AGGREGATE LIMIT APPLIES PER:PRO-

POLICY | A ] JE'CT I A I LOG

OTHER:AUTOMOBILE LIABILin'

x

x

ANY AUTO

OWNEDAUTOS ONLYHIREDAUTOS ONLY

UMBRELLA LIAB

EXCESS LIAB

SCHEDULEDAUTOSNON-OWNEDAUTOS ONLY

< OCCUR

CLAIMS-MADE

_DED I x I RETENTION $ nWORKERS COMPENSATIONAND EMPLOYERS'LIABILITY Y;NANYPROPRIETOR/PARTNEFUEXECUTIVEOFFICEFyMEMBEREXCLUDED?(Mandatory in NH)ff yes, describe underDESCRIPTION OF OPERATIONS below

ADDLINSD

Y

Y

N;A

SUBRWVD

Y

POLICY NUMBER

DTC06G424010COF19

BA3L0204331926

CUP9H4049031926

UB9J5626481926G

POLICY EFF(MM/DD/YYm

1/1/2019

1/1/2019

1/1/2019

1/1/2019

POLICY EXP(MMfDD/YYYY)

1/1/2020

1/1/2020

1/1/2020

1/1/2020

LIMITS

EACH OCCURRENCEDAMAGE TO RENTEDPREMISES (Ea occurrance)

MED EXP (Any one person)

PERSONAL &ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGO

COMBINED SINGLE LIMIT(Ea accident)

BODILY INJURY (Per person)

BODILY INJURY (Per accident) ]PROPERTY DAMAGE(Per accident)

EACH OCCURRENCE

AGGREGATE

PER I I OTH-STATUTE I I ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEEI

E.L. DISEASE - POLICY LIMIT

$1,000,000

$300,000

$10,000

$1,000,000

$2,000,000

$2.000.000

s

$1,000,000

$

$

$

$

$4,000,000

$4,000,000

s

$1,000,000

$1,000,000

$1,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)City of Lincoln and Lancaster County and Lincoln-Lancaster County Public Building Commission are additional insured for general liability and auto liability ifrequired by written contract executed prior to loss. Waiver of Subrogation applies for workers compensation if required by written contract executed prior to loss.The general liability, auto liability and workers compensation policies have been endorsed to provide 30 days notice of cancellation.

CERTIFICATE HOLDER

City of LincolnLancaster CountyLincoln-Lancaster County PublicBuilding Commission555 S. 10th StreetLincoln NE 68508

CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.

AUTH08I2ED REPRESENTATIVE

ACORD25(2016/03)© 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks ofACORD

TRAVELERSJ

POLICY NUMBER: DT-CO-6G42401 O-COF-1 9

EFFECTIVE DATE: 01 -01 -1 9

ISSUE DATE: 01-09-19

LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS

THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTSBY LINE OF BUSINESS.

IL TO 02 11 89IL T8 01 10 93I L TO 01 01 07I L TO 03 04 96IL T8 03

COMMON POLICY DECLARATIONSFORMS, ENDORSEMENTS AND SCHEDULE NUMBERSCOMMON POLICY CONDITIONSLOCATION SCHEDULEGENERAL PURPOSE ENDORSEMENT

GENERAL LIABILITY - CONTRACTORS

CG TOCG D3CG TOCG TOCG TOCG 00CG D4CG D4CG D2CG D2CG D2CG D2CG D3CG D2CG D2CG D2CG D3CG D3CG D3CG D3CG D5CG D6CG D7CG DOCG D1CG D2CG D2CG D2CG T3CG T4CG T4CG TOCG TOCG T1

02030304

01 11 0305 07 0807 09 8708 11 0334 11 0301 10 0120 07 0871 01 1503 12 9711 01 0446 08 0547 08 0516 11 1143 0188 1193 1122 0126 10 1156 05 1491 08-1346 10 1118 10 1146 01 1576 06 9342 01 9904 12 1740 09 1542 01 0220 11 0378 02 9081 11 8809 09 9343 01 1601 01 16

COML GENERAL LIABILITY COV PART DECDEDUCTIBLE LIABILITY INSURANCEDECLARATIONS PREMIUM SCHEDULEKEY TO DECLARATIONS PREMIUM SCHEDULETABLE OF CONTENTSCOMMERCIAL GENERAL LIABILITY COV FORMAMEND OTHER INS CQND MEAN OTHER INS/INSRAMEND COVERAGE B - PERS & ADV INJURYAMEND-NON CUMULATION OF EACH OCCDESIGNATED PROJECT(S) GEN AGGR LIMITBLANKET ADDITIONAL INSURED (CONTRACTORS)ADDITIONAL INSURED ( CONTRACTORS)CONTRACTORS XTEND ENDORSEMENTFUNGI OR BACTERIA EXCLUSIONEMPLOYMENT-RELATED PRACTICES EXCLUSIONEXCL-CONSTRUCT MANAGE ERRORS & OMISSIONSEXCLUSION-SUITS BY ONE NAMED INSUREDEXCLUSION - UNSOLICITED COMMUNICATIONMOBILE EQUIP REDEFINED-EXCL OF VEHICLESEXCL-PROd SUBJ TO WRAP-UP-LTD EXCEPTIONSEXCL - ARCHITECT/ENG/SURVEY PROF SERVEXCL-VIOLATION OF CONSUMER FIN PROT LAWSEXCL-ACCESS OR DISCL OF CONF/PERS INFOEXCLUSION-LEADEXCLUSION-DISCRIMINATIONEXCL-EXTERIOR INSULATION & FINISH SYSTEMEXCLUSION -SILICA OR SILICA-RELATED DUSTEXCLUSION WAREXCL-ALL POLLUTION INJURY OR DAMAGEEXCLUSION-ASBESTOSEXC-HAZARD-CONNECTED DESIGNATED EXPOSUREEMPLOYEE BENEFITS LIAB COV PART DECEMPLOYEE BENEFITS LIAB TABLE OF CONTENTSEMPLOYEE BENEFITS LIABILITY COV FORM

ILT801 1093017276

PAGE ; 1 OF


THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY

BLANKET ADDITIONAL INSURED(CONTRACTORS)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILIPi/ COVERAGE PART

1. WHO IS AN INSURED - (Section II) is amendedto include any person or organization that youagree in a "written contract requiring insurance"to include as an additional insured on this Cover-age Part, but:

a) Only with respect to liability for "bodily injury","property damage" or "personal injury"; and

b) If, and only to the extent that, the injury ordamage is caused by acts or omissions ofyou or your subcontractor in the performanceof "your work" to which the "written contractrequiring insurance" applies. The person ororganization does not qualify as an additionalinsured with respect to the independent actsor omissions of such person or organization.

2, The insurance provided to the additional insuredby this endorsement is limited as follows:

a) In the event that the Limits of Insurance ofthis Coverage Part shown in the Declarationsexceed the limits of liability required by the"written contract requiring insurance", the in-surance provided to the additional insuredshall be limited to the limits of liability re-quired by that "written contract requiring in-surance". This endorsement shall not in-crease the limits of insurance described inSection III - Limits Of Insurance.

b) The insurance provided to the additional in-sured does not apply to "bodily injury", "prop-erty damage" or "personal injury" arising outof the rendering of, or failure to render, anyprofessional architectural, engineering or sur-veying sen/ices, including;

i. The preparing, approving, or failing toprepare or approve, maps, shop draw-

ings, opinions, reports, surveys, field or-ders or change orders, or the preparing,approving, or failing to prepare or ap-prove, drawings and specifications; and

ii. Supervisory, inspection, architectural orengineering activities.

c) The insurance provided to the additional in-sured does not apply to "bodily injury" or"property damage" caused by "your work"and included in the "products-compteted op-orations hazard" unless the "written contractrequiring insurance" specifically requires youto provide such coverage for that additionalinsured, and then the insurance provided tothe additional insured applies only to such"bodily injury" or "property damage" that oc-curs before the end of the period of time forwhich the "written contract requiring insur-ance" requires you to provide such coverageor the end of the policy period, whichever isearlier.

3. The insurance provided to the additional insuredby this endorsement is excess over any valid andcollectible "other insurance", whether primary,excess, contingent or on any other basis, that isavailable to the additional insured for a loss wecover under this endorsement. However, if the"written contract requiring insurance" specificallyrequires that this insurance apply on a primarybasis or a primary and non-contributory basis,this insurance is primary to "other insurance"available to the additional insured which coversthat person or organization as a named insuredfor such loss, and we will not share with that"other insurance". But the insurance provided tothe additional insured by this endorsement still isexcess over any valid and collectible "other in-surance", whether primary, excess, contingent or

on any other basis, that is available to the addi-tional insured when that person or organization isan additional insured under such "other insur-ance".

4. As a condition of coverage provided to theadditional insured by this endorsement:

a) The additional insured must give us writtennotice as soon as practicable of an "occur-rence" or an offense which may result in aclaim. To the extent possible, such noticeshould include:

CG D2 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 20172B8


i. How, when and where the "occurrence"or offense took place;

ii. The names and addresses of any injuredpersons and witnesses; and

iii. The nature and location of any injury ordamage arising out of the "occurrence" oroffense.

b) If a claim is made or "suit" is brought againstthe additional insured, the additional insuredmust:

i. Immediately record the specifics of theclaim or "suit" and the date received; and

ii. Notify us as soon as practicable.

The additional insured must see to it that wereceive written notice of the claim or "suit" assoon as practicable.

c) The additional. insured must immediatelysend us copies of all legal papers received inconnection with the claim or "suit", cooperatewith us in the investigation or settlement ofthe claim or defense against the "suit", andotherwise comply with all policy conditions.

d) The additional insured must tender the de-fense and indemnity of any claim or "suit" to

any provider of "other insurance" which wouldcover the additional insured for a loss wecover under this endorsement. However, thiscondition does not affect whether the insur-ance provided to the additional insured bythis endorsement is primary to "other insur-ance" available to the additional insuredwhich covers that person or organization as anamed insured as described in paragraph 3.above.

5. The following definition is added to SECTION V.DEFINITIONS:

"Written contract requiring insurance" meansthat part of any written contract or agreementunder which you are required to include aperson or organization as an additional in-sured on this Coverage Part, provided thatthe "bodily injury" and "property damage"oc-ours and the "personal injury" is caused by anoffense committed:

a. After the signing and execution of thecontract or agreement by you;

b. While that part of the contract oragreement is in effect; and

c. Before the end of the policy period.

Page 2 of 2 © 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05

POLICY NUMBER: BA-3L020433-19-26-G

EFFECTIVE DATE: 01/01/2019

ISSUE DATE: 01/08/2019

LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS

THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTSBY LINE OF BUSINESS

IL TO 02 11 89IL T8 01 01 01

IL TO 01 01 07

COMMON POLICY DECLARATIONSFORMS ENDORSEMENTS AND SCHEDULE NUMBERSCOMMON POLICY CONDITIONS

COMMERCIAL AUTO

CACACACACA

CACACACACACA

CACA

TOTOTOTOTO0001202199T4

T4T4

0102033031

0156017035

52

5974

02020202021011

1010

1102

0202

15151516151313

13131316

1516

CA T3 53 02 15CA 02 21 12 17CA T8 01 01 19

CA T4 45 04 09

BA- COVERAGE PART DECS (ITEMS 1 & 2)BUSINESS AUTO COVERAGE PART DECLARATIONS (ITEM 3)BUS AUTO COV PART DECLARATIONS-4&5BUSINESS AUTO/MC COV PART-UM SUPPL SCHDTABLE OF CONTENTS-BUSINESS AUTO COV FORMBUSINESS AUTO COVERAGE FORMNEBRASKA CHANGES

LESSOR - ADDITIONAL INSURED AND LOSS PAYEENEBRASKA UNINSURED AND WTOERINSURED MOTORISTS COVERAGENebraska Auto Medical Payments Coverage

SHORT TERM HIRED AUTO - ADDITIONAL INSURED AND LOSSPAYEEAMENDMENT OF EMPLOYEE DEFINITIONBLANKET ADDITIONAL INSURED - PRIMARY ANDNON-CONTRIBUTORY WITH OTHER INSURANCEBUSINESS AUTO EXTENSION ENDORSEMENTNEBRASKA CHANGES - CANCELLATIONDESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY

usLOSS PAYABLE CLAUSE

INTERLINE ENDORSEMENTS

IL T4 05 03 11 DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BYus

IL T4 12 03 15 AMNDT COMMON POLICY COND-PROHIBITED COVGIL 00 21 05 02 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD

FORM)IL TO 10 12 86 LENDER'S CERTIFICATE OF INSURANCE - FORM A

IL T8 01 01 01021677

PAGE: OF

COMMERCIAL AUTO

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BUSINESS AUTO EXTENSION ENDORSEMENT

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

GENERAL DESCRIPTION OF COVERAGE -This endorsement broadens coverage. However, coverage for anyinjury, damage or medical expenses described in any of the provisions of this endorsement may be excluded orlimited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply tothe extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover-age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en-dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.

A. BROAD FORM NAMED INSURED

B. BLANKET ADDITIONAL INSURED

C. EMPLOYEE HIRED AUTO

D. EMPLOYEES AS INSURED

E. SUPPLEMENTARY PAYMENTS - INCREASEDLIMITS

F. HIRED AUTO - LIMITED WORLDWIDE COV-ERAGE - INDEMNITY BASIS

G. WAIVER OF DEDUCTIBLE - GLASS

PROVISIONSA. BROAD FORM NAMED INSURED

The following is added to Paragraph A.1., Who IsAn Insured, of SECTION II - COVERED AUTOSLIABILITY COVERAGE:

Any organization you newly acquire or form dur-ing the policy period over which you maintain50% or more ownership interest and that is notseparately insured for Business Auto Coverage.Coverage under this provision is afforded only un-til the 180th day after you acquire or form the or-ganization or the end of the policy period, which-ever is earlier.

B. BLANKET ADDITIONAL INSURED

The following is added to Paragraph c. in A.1-,Who Is An Insured, of SECTION II - COVEREDAUTOS LIABILITY COVERAGE:

Any person or organization who is required undera written contract or agreement between you andthat person or organization, that is signed andexecuted by you before the "bodily injury" or"property damage" occurs and that is in effectduring the policy period, to be named as an addi-tional insured is an "insured" for Covered AutosLiability Coverage, but only for damages to which

H. HIRED AUTO PHYSICAL DAMAGE - LOSS OFUSE - INCREASED LIMIT

1. PHYSICAL DAMAGE - TRANSPORTATIONEXPENSES - INCREASED LIMIT

J. PERSONAL PROPERTY

K. AIRBAGS

L. NOTICE AND KNOWLEDGE OF ACCIDENT ORLOSS

M. BLANKET WAIVER OF SUBROGATION

N. UNINTENT10NAL ERRORS OR OMISSIONS

this insurance applies and only to the extent thatperson or organization qualifies as an "insured"

under the Who Is An Insured provision containedin Section II.

C. EMPLOYEE HIRED AUTO

1. The following is added to Paragraph A.1.,Who Is An Insured, of SECTION II - COV-ERED AUTOS LIABILITY COVERAGE:

An "employee" of yours is an "insured" while

operating an "auto" hired or rented under acontract or agreement in an "employee's"

name, with your permission, while performingduties related to the conduct of your busi-ness.

2. The following replaces Paragraph b. in B.5.,Other Insurance, of SECTION IV - BUSI-NESS AUTO CONDITIONS:

b. For Hired Auto Physical Damage Cover-age, the following are deemed to be cov-ered "autos" you own:

(1) Any covered "auto" you lease, hire,rent or borrow; and

(2) Any covered "auto" hired or rented byyour "employee" under a contract inan "employee's" name, with your

CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved.Includes copyrighted material of Insurance Services Office, Inc. with its permission.

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TRAVELERS J ' WORKERS COMPENSATION

ONE TOWER SQUAREHARTFORD CT~06183

ENDORSEMENT WC 00 0313 (00)- 001

POLICY NUMBER; UB-9J562648-19-26-G

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will notenforce our right against the person or organization named in the Schedule. (This agreement applies only to theextent that you perform work under a written contract that requires you to obtain this agreement from us.)

This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule.

SCHEDULE

DESIGNATED PERSON:

DESIGNATED ORGANIZATION:ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREEDBY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THISWAIVER.INCLUDING;INCLUDING CITY OF LINCOLN LANCASTER COUNTY LINCOLN-LANCASTERCOUNTY PUBLIC BUILDING COMMISSION 555 SO. 10TH STREETLINCOLN, NE 68508

011276 DATE OF ISSUE: 01-08-19 ST ASSIGN: PAGE 1 OF 1

amendment to contract inspection, testing and …

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